Canoe & Tube Rental Insurance Questionnaire

Rows	Enter number below
Concession Receipts ($)
Number of Stands
Square Footage

Rows	Enter Number Below
Ranges
Ovens
Deep Fryers
Grills
Broilers
Griddles

COMMERCIAL CRIME

1. Do you desire coverage for Crime (Employee Dishonesty, Money, Forgery)?

1a. If yes, requested amount?

OPTIONAL PROPERTY COVERAGES

1. Do you need Computer Coverage?

1a. If yes, amount needed?

2. Do you need Outdoor Sign Coverage?

3. Do you need Equipment Coverage?

3a. If yes, total value to insure for?

Total Value ($)

3b. If yes, please complete equipment schedule below or provide a separate equipment schedule with the following information:

Rows	Year	Make	Model	Value to Insure For ($)
Item 1
Item 2
Item 3

COMMERCIAL AUTOMOBILE INSURANCE

1. Does the business title any automobiles or other operating vehicles in the business name?

2. Is insurance coverage needed for owned automobiles?

2a. (If yes, complete chart below or provide a separate vehicle/fleet schedule with following info.)

Rows	Vehicle Make	Vehicle Model	Cost New ($)	Year
Vehicle 1
Vehicle 2
Vehicle 3

2b. If yes, limits desired:

Rows	Amount ($)
Limit of Liability
Comprehensive Deductible
Collision Deductible

3. Do any of the employees, owners or officers drive personally owned automobiles/other vehicles in the course of their work?

3a. If yes, how many?

3b. Do you verify they have liability coverage?

3c. Limits? ($)

COMMERCIAL UMBRELLA

1. Do you need a Commercial Umbrella?

1a. If yes, limit of liability needed? ($)

WORKERS' COMPENSATION INSURANCE

1. Do you need Workers Compensation? (If yes, please contact Kevin Morency.)

SIGNATURE

The information I have provided is true and accurate to the best of my knowledge. I have not willfully concealed or misrepresented any material fact(s) or information. I understand completion of this questionnaire does not compel the company to provide coverage.

Signature

Or Enter Your Full Name as Signature:

Date:

Questions? 877-244-9090
Kevin Morency | kmorency@morencyinsurance.com

Morency & Associates Inc.
141 New Shackle Island Rd, Hendersonville, TN 37075
Fax: 615-452-6580

https://familyfuninsurance.com/